Syncope: The Underestimated Threat in Severe Aortic Stenosis

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Severe aortic stenosis (AS) management involves assessing the risk-benefit ratio for surgical aortic valve replacement (SAVR).
• Cardinal symptoms of AS include angina, heart failure, and syncope, but their impact on post-SAVR outcomes is not fully understood.
• The significance of early symptom detection in asymptomatic AS patients requires further investigation.

Purpose of the Study:

• To evaluate the association between pre-operative symptoms and outcomes following SAVR in patients with severe AS.
• To determine if specific symptoms, particularly syncope, predict increased mortality risk after SAVR.

Main Methods:

• Prospective, long-term observational study.
• Enrolled 625 patients with isolated severe AS undergoing elective SAVR.
• Analyzed pre-operative symptoms in relation to post-operative mortality and other outcomes.

Main Results:

• Patients with syncope exhibited smaller cardiac dimensions, aortic valve areas, and lower stroke volumes.
• Syncope was significantly associated with increased short-term (1-year) and long-term (10-year) mortality after SAVR.
• Pre-operative dyspnea, angina, and reduced left ventricular function were not significantly linked to adverse outcomes.

Conclusions:

• Syncope is an underestimated predictor of poor prognosis in severe AS patients undergoing SAVR.
• Patients experiencing syncope present a distinct pathophysiological profile, including smaller cardiac structures and reduced stroke volumes.
• The findings emphasize the critical role of syncope assessment in pre-operative evaluation for SAVR.